Tuesday, November 15, 2005

Cellulitis - Page Two

Lymphedema People

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Cellulitis

Medline Plus Medical Encyclopedia
National Institutes of Health

Alternative names

Skin infection - bacterial

Definition

Cellulitis is an acute inflammation of the connective tissue of the skin, caused by infection with staphylococcus, streptococcus or other bacteria (see also cellulitis - streptococcal).

Causes, incidence, and risk factors

The skin normally has many types of bacteria living on it, but intact skin is an effective barrier that keeps these bacteria from entering and growing within the body. When there is a break in the skin, however, bacteria can enter the body and grow there, causing infection and inflammation. The skin tissues in the infected area become red, hot, irritated and painful.Cellulitis is most common on the face and lower legs, although skin on other areas of the body may sometimes be involved.

Risk factors for cellulitis include:

Insect bites and stings; animal bite or human bite
Injury or trauma with a break in the skin (skin
wounds)
History of
peripheral vascular disease
Diabetes-related or ischemic ulcers
Recent
cardiovascular, pulmonary (lung), dental or other procedures
Use of immunosuppressive or corticosteroid medications

Symptoms

Localized skin redness or inflammation that increases in size as the infection spreads

Tight, glossy, "stretched" appearance of the skin
Pain or tenderness of the area

Skin lesion/rash (macule):
Sudden onset
Usually with sharp borders
Rapid growth within the first 24 hours
Warmth over the area of redness
Fever
Other signs of infection:
Chills, shaking
Warm skin,
sweating
Fatigue
Muscle aches, pains (myalgias)
General ill feeling (malaise)

Additional symptoms that may be associated with this disease:
Nausea and vomiting

Joint stiffness caused by swelling of the tissue over the joint
Hair loss at the site of infection

Signs and tests

During a physical examination, the doctor may find localized swelling. Occasionally, swollen glands (lymph nodes) can be detected near the cellulitis.

Tests that may be used:

A CBC may show an elevated white blood cell count, and indicates a bacterial infection.
A
blood culture may be performed if generalized infection is suspected.

Treatment

Cellulitis treatment may require hospitalization if it is severe enough to warrant intravenous antibiotics and close observation. At other times, oral antibiotics and close outpatient follow-up suffice. Treatment is focused on control of the infection and prevention of complications.Antibiotics are given to control infection, and analgesics may be needed to control pain.Elevate the infected area, usually higher than the heart, to minimize swelling. Apply warm, moist compresses to the site to aid the body in fighting infection by increasing blood supply to the tissues. Rest until symptoms improve

Expectations (prognosis)

Cure is possible with 7 to 10 days of treatment. Cellulitis may be more severe in people with chronic diseases and people who are susceptible to infection (immunosuppressed).

Complications

Tissue death (gangrene)
Sepsis, generalized infection and shock
Meningitis (if cellulitis is on the face)
Lymphangitis (inflammation of the lymph vessels)

Calling your health care provider

** Immediately as a patient with lymphedema**
Call your health care provider if symptoms indicate that cellulitis may be present.Call your health care provider if you are being treated for cellulitis and new symptoms develop, such as persistent
fever, drowsiness, lethargy, blistering over the cellulitis, or extension of the red streaks.

Prevention

Avoid skin damage by wearing appropriate protective equipment when participating in work or sports. Also clean any breaks in the skin carefully and watch for redness, pain, drainage, or other signs of infection.

Finally, maintain good general health and control chronic medical conditions. A body that is healthy can more easily fight bacteria before they multiply and cause infection, while a body that is run down has less protection against infection.Update Date: 10/25/2002
Updated by: Michael Lehrer, M.D., Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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Cellulitis

What Is It?

Cellulitis is a serious bacterial infection of the skin. In cellulitis, bacteria penetrate the skin's protective outer layer, typically at the site of an injury, such as a cut, puncture, sore, burn or bite. Cellulitis also can occur at the site of surgery, or where the skin was punctured for a small plastic tube (intravenous catheter) used to administer medications. Once inside the skin, the invading bacteria multiply and produce chemicals that cause inflammation within the skin.
Cellulitis usually occurs on the legs and feet. However, it can develop on any part of the body, including the trunk, arms and face. It often develops near an area where there already is swelling, poor blood flow, or another skin condition such as a fungus infection between the toes
(athlete's foot).

Many different types of bacteria can cause cellulitis. However, most cases are caused by Streptococcus pyogenes (strep) or Staphylococcus aureus (staph). Other types of bacteria can cause infection after certain types of skin injuries, such as animal bites, puncture wounds through wet shoes, and wounds exposed to freshwater lakes, aquariums, or swimming pools.

Cellulitis can take several specific forms, including:

Periorbital cellulitis, a skin infection around the eye sockets (orbits) — Often, this is caused by Haemophilus influenza, a type of bacterial infection that is common in children. Because infection around the eye can spread to the brain, periorbital cellulitis requires prompt medical attention.

Erysipelas, a form of skin infection that produces raised, firm, bright red patches of skin — Usually, it is caused by Streptococcus bacteria. Erysipelas occurs most often on an arm or leg that has been damaged by previous surgery or is chronically swollen due to poor lymph flow (lymphedema). Erysipelas also can develop on the face, typically across the bridge of the nose and upper cheeks.

Necrotizing fasciitis, also known as "flesh-eating strep" — This is an infection of the tissues below the skin, rather than the skin itself. Often, the overlying skin is discolored and extremely painful. Fasciitis is a life-threatening infection that requires prompt medical attention.

Symptoms

In cellulitis, the affected area of skin feels warm and usually is red, swollen and painful. The redness can be vague or can stand out compared to surrounding skin. The area of warmth can be felt with the back of the hand, especially when compared to surrounding skin. There may be a spreading network of red streaks in the skin, caused by infection in the vessels that carry lymph (tissue fluid), as well as enlarged lymph nodes (swollen glands) near the area of infection.
Fever and malaise (a generally sick feeling) often accompany cellulitis. Severe infections can cause low blood pressure if bacteria get into the bloodstream. Bloodstream infections (blood poisoning) from cellulitis are particularly dangerous in the very young and very old, as well as in those with weakened immune systems or abnormal heart valves.

Diagnosis

Your doctor will ask you about how your cellulitis developed and your symptoms, including whether you have:

Had recent injuries such as cuts, scrapes, bites, or puncture wounds
Previously injured the area or been operated on there
Had unusual exposures such as fish tanks, pond water, or animals
Underlying medical problems that increase your risk for complications
Shaking chills or other symptoms that suggest the infection has spread to the bloodstream or to surrounding organs

Many people who develop cellulitis have no underlying medical problems and no obvious injury or skin damage that allowed the infection to occur.

Your doctor can diagnose cellulitis based on the history of your injury, your symptoms, and the results of a physical examination. If your skin wound is draining fluid or pus, your doctor may take a sample of wound drainage for tests to identify the type of bacteria and use specific antibiotics to eliminate the bacteria.

Expected Duration

How long cellulitis lasts depends on the type of skin injury, the bacteria that caused the infection, and your general health. Without proper antibiotic treatment, some forms of cellulitis can cause serious complications within a few days, even in otherwise healthy patients.

Prevention
To help prevent cellulitis:

Prevent skin injury — Wear protective gloves while gardening and working outdoors. Wear long sleeves and trousers while hiking, and avoid going barefoot outdoors. Wear protective padding on elbows and knees while skating.

Treat minor skin wounds promptly — Gently wipe away any dirt, wash with antibiotic soap, apply antibiotic ointment, and cover with a clean bandage.

Seek medical attention — Medical attention is needed for all deep puncture wounds and animal bites and for all deep wounds involving a joint, hand or foot.

Treatment

Cellulitis is treated with antibiotics. Your doctor will choose a specific antibiotic depending on the location of your cellulitis and the likely cause of your infection. Most cases of cellulitis improve quickly once antibiotics are given.

If you have mild cellulitis, you probably can be treated at home with antibiotics taken by mouth. However, you must keep in close contact with your doctor to be sure that the infection is improving as expected. At home, warm compresses, such as a warm, moist washcloth, and elevation of the infected area can help. If you have severe cellulitis, you may need to be treated in the hospital with antibiotics given intravenously (into a vein).

When To Call A Professional

Call your doctor whenever a skin injury becomes red, warm, swollen or tender. Call your doctor promptly if you get a deep puncture wound, especially on a hand or foot, or if you are bitten by an animal or human.

Prognosis

In most cases, symptoms of cellulitis begin to improve within 24 to 48 hours of starting treatment with appropriate antibiotics. You should always take all the antibiotics prescribed by your doctor, even if you think your infection has been cured.

Additional Info

National Center for Infectious DiseasesOffice of Health CommunicationCenters for Disease Control and PreventionMailstop C-141600 Clifton Rd., NEAtlanta, GA 30333Toll-Free: (888) 232-3228http://www.cdc.gov/ncidod/
Last updated December 03, 2003

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